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Data:2009-12-12 2:34
Recently, Takako's Miss Lu Xi De obtained from the social security department of the maternity medical costs 2,500 yuan subsidy. Inpatient medical costs to insurance companies for claims, the insurance companies have paid social security subsidies Miss Lu's medical expenses, are therefore not paid.
A case of playback
The beginning of 2004, in Shanghai, a job at a trading company Miss Lu pleased to find themselves pregnant with a baby. About pre-birth in October, to coincide with the Lunar Year of the Monkey, Golden Monkey send-hi, a person smile.
October conceive, in order to ensure the baby and their own health, Miss Lu cautious, often to the hospital for check-ups. Seeing that the pre-production period is approaching, and talked under tocolysis Miss Lu was admitted to the hospital, and a smooth birth to a large Pan Xiaozi.
Happily out of the hospital, Miss Lu while resting at home, while the insured based on their in-patient medical insurance claims paid to the insurance company's application. After hearing the news, the unit's colleagues were also the first time holding flowers and nutritional supplements to come to visit congratulations, but also brings the Shanghai Labor and Social Security Bureau issued to Miss Lu's 2,500 yuan subsidies for maternity medical expenses.
A few days later, Miss Lu's insurance agent called the phone, said that due to social security has been given 2,500 yuan to subsidize medical expenses for childbirth, Miss Lu sufficient to cover hospital costs, so in-patient health care in the commercial insurance are not paid on the .
Miss Lu was puzzled. "I was hospitalized before production, to the hospital for a few checks, the application of these costs, the insurance companies are quickly approved a down payment. Why is the social security payment of medical expenses after their fertility, he can not obtain commercial insurance claims do?" Miss Lu dial to call to the Articles, for doubt in his heart to seek advice.
2 hot Feedback
The author and Miss Lu's insurance company to get in touch soon after received a reply: As Miss Lu-patient medical insurance claims are making it up when you type, that is, the customer can not get more than she actually spent in the interests of hospital medical expenses Otherwise, they would belong to unjust enrichment.
This is also the general principles of hospital health care insurance. Miss Lu received 2,500 yuan for medical expenses maternity allowance has been sufficient to cover her medical costs, so no need to repeat the commercial insurance payment.
To protect the fertility of women during childbirth basic living and medical needs, but also to further reduce the burden on the employing unit, the Shanghai promulgated and amended the "Shanghai urban maternity insurance approach" to raise the level of insurance to childbearing women.
"Procedures" provides, you can apply for maternity insurance coverage of women must meet the following conditions: (a) with city urban household registration; (b) to participate in this city the urban social insurance; (3) belongs to plan parenthood; (d) In accordance with requirements set obstetrics, gynecology medical institutions in production or abortion (including spontaneous abortions and abortions).
Maternity insurance benefits consist mainly of including the payment of subsistence allowance on fertility and reproductive health care expenses subsidized two, in addition to the many that may occur during pregnancy and the risk of accidents also made detailed provisions of, respectively, to develop standards for different payments.
7 months of pregnancy (including 7 months) or more production or less than 7 months of pregnancy, premature birth, birth medical expenses from the original 2,500 yuan subsidy adjusted to 3,000 yuan; pregnancy 3 months (including 3 months) for more than 7 months The following spontaneous abortion, maternity subsidies for medical expenses from the original 400 yuan adjusted to 500 yuan; 3 months of pregnancy following spontaneous abortion, maternity subsidies for medical expenses from the original 200 yuan adjusted to 300. "Procedures," a clear and childbearing, child-bearing women's reproductive lives a half-month allowance from the original adjusted to 1 month.
Unemployed women receiving maternity allowance after living is no longer enjoy the "Shanghai unemployment insurance scheme," under the maternity benefits, unemployment occurred in women's reproductive examination fees, medicines, hospitalization for medical expenses exceeded the standard maternity allowance for medical expenses of more than part of the can still click "Shanghai unemployment insurance scheme" requirement to apply for Medicaid payments.
3 Notes from Interview
I subsequently asked questions about Miss Lu several other insurance companies, the answer given are different.
Most life insurance companies, said conceive and give birth does not belong to the disease category, so if Miss Lu buying their company's health insurance, in view of pregnancy, hospitalization due to illness or accidental injury was not caused, will not be the hospital medical insurance or accidental injury within the responsibility of medical insurance.
In other words, pregnant patient in a number of insurance companies are deductible medical insurance liability provisions.
But we all know, pregnancy bears a greater risk of having children. If one is in pregnant women who wish to purchase insurance during the period of her application for insurance submitted by many insurance companies will be cautious.
In general, the insurance only accept applications for insurance cover the following seven months pregnant, for more than seven months pregnant clients, applications for insurance cover will not be accepted provisionally, pending a two-month postpartum and the health of the insured person before they can apply.
For customers, the following seven months pregnant, in principle, does not accept medical insurance, critical illness insurance and accident insurance, only to accept the responsibility that does not contain more than the other life, but also in insurance to be carried out general medical examination. In addition to incidents because of birth was listed as exclusions insurance company.
High-risk pregnancy, expectant mothers should take precautions before pregnancy or during pregnancy, the timely selection of women who cover all kinds of special risk insurance.
These products will have a particular surgery and diagnosed with the disease suffer from the contract sum insured according to the basic pay multiplied by the corresponding ratio, payment of pregnancy sickness medical insurance.
Some insurance also provides newborn is "collateral insured person" was born 7 days before the six years of age suffering from certain congenital diseases diagnosed by one of the payment congenital insurance Jin 3 million, was born 7 days before the death of six years of age , death insurance money paid 20,000 yuan.
Pregnancy the disease is usually not part of critical-illness insurance coverage, therefore, women should consider selecting highly targeted insurance female insurance.
While the general provisions of the medical and hospitalization insurance hospitalization because of pregnancy, the costs incurred by having children belong to scope of exemption, but many insurance companies are also specially designed a special insurance for women, for women's unique medical expenses during the corresponding payment for this type of special risks to provide comprehensive protection.
In addition, because women during pregnancy higher than normal probability of risk, usually the insurers for coverage of pregnant women have some limitations.
If it is determined there is coverage needs during pregnancy, then in addition to careful selection of the insurance liability insurance products, but also note that the timing of insurance, the insured as soon as possible to avoid the insurance companies do not cover periods.
